Head games: With concussion concerns on the rise, high school football officials and scientists focus on ways to increase safety

Las Vegas Sun

February 29, 2020

High school football players in Nevada aren’t allowed to practice in shoulder pads and helmets until a few weeks before the season starts. Even then, athletes are required to practice without pads for three days before the transition—which, of course, brings on tackling.

In total, there are 10 practices before an athlete can participate in a game, an introductory time state athletic officials say is vital in helping limit injuries. “Coaches are trained on concussions, which bring further awareness to the issues,” says Rich Muraco, Liberty High School’s football coach and president of the Southern Nevada High School Football Coaches Association. “Thank God we have trainers, because it takes a lot of pressure [off] us.”

High school sports participation is trending down for the first time in 30 years, and a national decline in football participation is a significant reason why, a survey conducted by the National Federation of State High School Associations (NFHS) reveals.

Even though the number of schools offering football has remained steady, participation dropped to 1,006,013 in the 2018-19 school year, the lowest mark since 1,002,734 for the 1999-2000 school year, according to the federation. That’s partially due to concerns surrounding the risk of injury, such as concussions and other more severe traumatic brain injuries, federal officials noted.

One recent peer-reviewed study reported that concussion rates during high school football games are on the rise. The study, released in October by Pediatrics, the official journal of the American Academy of Pediatrics (AAP), concluded that football had the highest concussion rate at 10.4 per 10,000 exposures, followed by girls’ soccer at 8.19 and boys’ ice hockey at 7.69.

But Donnie Nelson, assistant director of the Nevada Interscholastic Activities Association (NIAA), says high school football is safer than ever before. “Our leaders at the NFHS have returned that there is a decreasing number of concussions in practices as well, because of the limited time designated for full contact [drills, plays, etc.],” he says. “The preseason policies adopted by our NIAA schools have our coaches saying the same things.”

It’s important to note that researchers from the AAPstudy concluded that while concussions during games were on the rise, concussion rates during practice have declined over the past five years. In Nevada, football concussion rates have taken a slight dip, from 102 cases in 2015 to 96 cases in 2018.

In Nevada, participation in high school football has also been on the rise since bottoming out in 2017 at 6,781. In 2019, that number rose to 8,147. Nelson notes that some schools in Nevada have doubled their teams, so the number is probably closer to 7,400.

“We believe the football participation number will continue to grow, as the youth leagues also seem to be rebounding after their low some five to seven years ago,” Nelson says. “The increase in youth participation numbers is trickling up now.”

For that, Nelson credits the way game-playing rules and strategies have evolved over the years.

Ahead of the curve
In 2011, Nevada enacted a law requiring the NIAA to adopt guidelines and protocols to address sports injuries like concussions. Athletes who exhibit signs or symptoms that appear consistent with a concussion—loss of consciousness, balance problems, headache, dizziness or confusion—must immediately be removed from games or practices, returning only until after they have been cleared by a qualified health care professional.

Nevada schools were ahead of the issue before these rule changes. In 2004, the Clark County School District instituted the ImPACT evaluation system to clear athletes for concussion before going back onto the field. ImPACT, an online tool, tests each athlete’s memory, attention span and problem-solving skills. Players are then required to go through a series of additional balance and physical stress tests.

Muraco says NFHS encourages rugby-style tackling, done by driving a shoulder into an opposing player’s hip, wrapping him up and taking him to the ground while the defensive player keeps his head to the side of the body.

Muraco, who has also coached wrestling, baseball, track and field and flag football, says concussions were generally taken seriously if players exhibited more extreme symptoms such as dizziness, light sensitivity or loss of consciousness. “Even the kids themselves wouldn’t report the lesser symptoms,” he says. “When things didn’t stand out as obvious, we didn’t know any better, so we may have rushed some kids to play that we shouldn’t have.”

Coaches now receive training on how to detect concussions, and Clark County schools also have athletic trainers to assess a player’s injury. “We really were one of the top districts in the country when it came to the concussion protocol and identifying player safety,” Muraco says.

Concussion study
While there have been strides made in the sports industry with regards to mitigating the risks associated with concussions and traumatic brain injury, there are still quite a few unknowns when it comes to brain injuries in athletes.

Concussions can range in severity and are often unpredictable, UNLV researcher Jefferson Kinney says. The founding chair of the school’s brain health department, Kinney explains that concussions can cause subtle difficulties in cognitive function or motor coordination, along with memory loss and behavioral problems. It’s a subject Kinney hopes to tackle through a collaborative effort with the Cleveland Clinic Lou Ruvo Center for Brain Health and Indiana University.

Kinney says he believes the keys to diagnosing these injuries are blood-based biomarkers—proteins in the blood that can be used to indicate the presence of a disease. He plans to build upon the research his team has already done studying mixed martial arts fighters, which has shed some light on the difference between athletes and control groups. The next step is to turn the research into a systemic investigation.

Kinney says, in particular, he hopes to understand whether one massive blow to the head has more severity than several, smaller sub-concussive blows. “When someone loses consciousness, everyone understands that’s a problem,” he says. “But if it’s a small blow, oftentimes trainers and coaches can’t detect it. Each may vary in the level of severity, but there may be some carryover, which may lead to a problem.”

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